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01.06.2011

Laparoscopic colectomy and restorative proctocolectomy for familial adenomatous polyposis

verfasst von: Marco Vitellaro, Giuliano Bonfanti, Paola Sala, Elia Poiasina, Marta Barisella, Stefano Signoroni, Andrea Mancini, Lucio Bertario

Erschienen in: Surgical Endoscopy | Ausgabe 6/2011

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Abstract

Background

Familial adenomatous polyposis (FAP) is a dominantly inherited syndrome. Risk of cancer begins to increase after age 20 years if not treated. The purpose of this study was to evaluate the feasibility and short- and long-term outcomes after laparoscopic prophylactic surgery for FAP.

Methods

Fifty-five patients with FAP were identified through the Hereditary Colorectal Tumor Registry from 2003 to 2009. Patients with laparoscopic total colectomy (TC)/IRA or proctocolectomy (TPC)/ileal pouch-anal anastomosis IPAA were included. Patients with previous colon or abdominal major surgery, malignancy, and desmoids before surgery were excluded. Main outcomes were: 30 days anastomotic leak and pouch failure; long-term desmoids and malignant recurrence.

Results

Of the 55 patients, 32 were men, median age was 28 years, and mean body mass index was 23. Median follow-up time was 36 (range, 5–77) months. Forty-four patients had laparoscopic TC/IRA and ten had laparoscopic TPC/IPAA. One patient was converted to open surgery and received an open TPC/IPAA. Incision length was 7 (range, 5–14) cm. Anastomotic leak was 3 (5.4%: 2 laparoscopic and 1 open), and pouch failure was 0. Median postsurgical length of stay was 7 (range, 4–24) days. Desmoids occurred in three patients (5.4%), and there was no malignant recurrence within the follow-up period. Pathology revealed severe dysplasia in ten patients and adenocarcinoma in nine (8 laparoscopic and 1 open). Long-term small-bowel obstruction was 2 (3.6%). One mortality due to liver metastases occurred at 24 months.

Conclusions

Laparoscopic prophylactic treatment of FAP appears to be safe and feasible and may be an appealing alternative to open surgery. If the goal of prophylactic FAP surgery is to avoid cancer occurrence, laparoscopic surgery could be an important advancement.

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Titel: Laparoscopic colectomy and restorative proctocolectomy for familial adenomatous polyposis
verfasst von: Marco Vitellaro
Giuliano Bonfanti
Paola Sala
Elia Poiasina
Marta Barisella
Stefano Signoroni
Andrea Mancini
Lucio Bertario
Publikationsdatum: 01.06.2011
Verlag: Springer-Verlag
Erschienen in: Surgical Endoscopy / Ausgabe 6/2011
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1478-z

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